Exposure and Response Prevention: Evaluation of Tic Severity Over Time for Children and Adolescents with Tourette Syndrome and Chronic Tic Disorders

Abstract

Tourette Syndrome and Chronic tic disorders are characterized by the presence of tics. Different behavioral therapies have shown to be efficacious for treating tics in children and adolescents, but Exposure and Response Prevention (ERP) is a less researched method. However, ERP is a method often used in the clinical setting. Therefore, the present study evaluated the severity of tics over time from beginning of ERP to follow-up approximately one year after last training session. 116 patients treated with ERP face-to-face or ERP via web-based videoconferencing were included. Primary outcome measure was tic severity measured with the Danish version of the Yale Global Tic Severity Scale. The results showed that tic severity decreased during ERP and lasted in the follow-up period, with a statistically higher decrease in the group with patients who completed ERP as planned and the group that stopped earlier than planned because of reduction in tics, compared to those who dropped out due to lack of motivation (p<0.001). The study concludes that ERP seems to have an immediate and a long-term effect on severity of tics, especially in those who complete the programme or those who discontinue earlier due to good results.

Tourette syndrome research highlights from 2022

“…The videoconference format was also partly used in a naturalistic study of ERP conducted at a TS/CTD specialist clinic in Denmark. In this study by Sørensen and colleagues ( Sørensen et al . 2023a , 2023b ), 116 youth received ERP (either face-to-face [n = 72] or via videoconference [n = 44]) and were followed up one-year post-treatment.…”

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“…I lys av dette foreslo Swedo et al (1998) følgende arbeidskriterier for den kliniske diagnosen PANDAS (Swedo et al, 1998) (Sorensen et al, 2018;Swedo et al, 1998;Williams & Swedo, 2015).…”

PANDAS: behov for nasjonale retningslinjer

“…Tilstedevaerelse av tics og/eller tvangslidelse med kriteriene fra DSM-III eller DSM-IV oppfylte Prepubertal debut Akutt debut og/eller forverringer med et episodisk sykdomsforløp Tidsmessig relasjon mellom GAS-infeksjon og debut og/eller forverringer Nevrologiske avvik som tics-forstyrrelse, koreiforme bevegelsesforstyrrelser eller motorisk hyperaktivitet under forverringer Angitte psykiatriske tilleggsdiagnoser hos pasienter som oppfyller de foreslåtte PANDAS-kriteriene inkluderer angst, ADHD og depresjon. Spisevegring, søvnforstyrrelser, irritabilitet, aggresjon, opposisjonell atferd, vannlatingsproblemer og reduserte skoleprestasjoner rapporteres som hyppige tilleggsvansker (Sorensen et al, 2018;Swedo et al, 1998;Williams & Swedo, 2015).…”

“…Publiserte data er stort sett case-rapporter og studier av lav kvalitet, til tross for at PANDAS-akronymet ble presentert for over 20 år siden. Det er i dag anerkjent at det innen pasientgruppen med tics og tvangslidelse finnes en undergruppe med rask debut og episodisk forløp, men en sammenheng med GAS-infeksjon er fremdeles kontroversiell (Pichichero, 2019;Sorensen et al, 2018;Williams & Swedo, 2015), og det er ikke vist klar evidens for spesifikk behandling.…”